Rescripting Suicidal Mental Imagery in Young People: A Pilot Study of Feasibility, Acceptability and Safety

Suicidal mental imagery-vivid, intrusive mental images of suicide or death-is common among young people experiencing suicidal ideation and may increase risk of suicidal behaviour, yet interventions directly targeting these images are limited. We conducted a single-arm pilot study evaluating the feasibility, acceptability and safety of a brief, therapist-delivered imagery rescripting intervention targeting action-facilitating suicidal mental imagery in help-seeking young people aged 16-25 years with mood disorders and current or recent suicidal ideation. Fifteen participants were recruited; 12 were eligible for the intervention and 11 (92%) completed treatment and follow-up. The recruitment target (N = 25) was not met, largely due to service disruptions and clinician capacity constraints. Acceptability and safety criteria were met: 73% reported that sessions were not distressing, none felt less safe following treatment, and no participant showed increased suicidal ideation from baseline to follow-up. Two serious adverse events occurred but were judged unrelated to the intervention. Exploratory analyses showed reductions in suicidal-image frequency, realness, compellingness, intrusiveness and distress, alongside a 62.5% reduction in suicidal ideation severity. Our pilot study provides preliminary indications that directly rescripting action-facilitating suicidal mental imagery showed encouraging short-term safety and acceptability signals in young people, supporting evaluation in a larger randomised controlled trial.